UKOMBOZI SACCO LTD

P.O Box 2758 – 20100 Nakuru Tel: 0719 312307, 0737 035736; Email: info@ukombozisacco.com;
Website: www.ukombozisacco.com
Together for a brighter future
BIASHARA LOAN FORM Loan No.………………..

I………………………………………………………………………………………………………………Membership Number …..……………………………….

Hereby apply for a loan of Kshs ………………………………... Amount in words…………………………………………………………………………
…………………………………………………………………………..… to be paid in……………………………………, monthly installments at an
interest rate of 1% per month reducing balance method(Maximum repayment period 18 months).
A. PERSONAL INFORMATION:
1. Cell phone: ……………………………………………………………… 2. Address: ………….……….…………………………………………………….
3. A/c Number: …………….…………………………………………….. 4. Bank name: …………………………………………………………………….
5. Branch Name: …………………………………………………………. 6. Monthly income Kshs: ……………………………………………………
7. Monthly expenditure Kshs: ….….……………….…………….. 8. Region: …………………………………………………………………………..
9. County: …………………..………….…………………………………… 10. Church: ………………………………………..………………………………
11. Employers Name (If employed): …………………………….. 12. Employers Address: ………..……………………………………………
13. Employers Telephone/ Cell: …..….…………….……….……

B. PURPOSE FOR WHICH LOAN IS APPLIED

1. ………………………………………………………….…………………………
2. ………………………………………………………………………………………

C. SECURITY OFFERED FOR THE LOAN

1. My deposits
2. Guarantor’s deposits

I hereby declare that the foregoing particulars are true to the best of my belief, knowledge and abiding to the rules set in
Society’s By- Laws, the loaning policy and any variations by the committee.

In case of default in repayment, the entire loan will immediately become due and payable at the BOD discretion and all
deposits I hold or any benefits due to me will be offset against the loan balance. Any remaining balance will be deducted
from my guarantors by authority of their signatures appended and lead to blacklisting with the Credit Reference Bureau.

I also confirm that I have authorized the Society to share my credit information, access my credit profile from Credit
Reference Bureau.

Applicant’s Signature: ……….……………………………… ID Number: ………………………….. Date: ………….…………………………………

Next of Kin Name: …………………………………..……….. Signature: …………………….……… Tel. Number: ……………...………………..

Witnessed by: ………………………………………………….. Signature …………………………….. Member No: ………………..……………….

(Attach photocopies of your ID and next of Kin or the witness.)

Nairobi Office Mombasa Office Eldoret Office Kitengela Office Karatina Office Nkubu Office Kisii Office Kisumu Office O. Rongai Office
0719 312 309 0716 130 883 0729 287 451 0748 080 119 0748 080 086 0719 834 321 0716 130 884 0719 772 099 0726 498 199
0782 301 313 0782 601 188 0782 850 884 0782 301 118 0782 605 508 0782 601 015 0782 601 415 0782 599 822 0782 601 010

Page 1 of 4
 D. REPAYMENT GUARANTEE

We the undersigned acting as guarantors for the loan requested on page one of this Agreement understand and agree
jointly and severally, that all shares and deposits with UKOMBOZI SACCO LTD OWNED BY US, are hereby Pledged as
security for the loan or such part of it as may be granted but not exceeding Kshs……………..……………………..………..… Amount
in words………………………………………………………………………………………………………………………………………….…………………………………..

Also we the undersigned hereby accept jointly and severally that In case of default in repayment by loanee, the SACCO is
authorized to deduct any balance and interest from the securities hereby pledged. We further understand that we shall
not be eligible for loans at the time the repayment of the loan is in default. Our particulars are as follows:

Member Member’s Name Deposits Deposits ID No. Signature

No. Guaranteed Available
Kshs (Official Use)
1
2
3
4
5
6
7
8
9
10
11
TOTALS

Official Use Only.

Guarantor's Eligibility verified & posted by:

Officers Name: …………………………………………………………………... Sign: ………………………………. Date…………/..………./………….

E. EMPLOYER OR YOUR PASTOR CONFIRMATION

Subject to rules and policy of the society I……………………………………………………………………………… support that the applicant is
employed / a member of ……………………………………………………..and I will inform UKOMBOZI SACCO LTD should the employee
/ the member leave the church or employment is terminated. (Cancel where not applicable to you). In case employed the
balance of the loan will be recovered from any benefits to the employee.

Signature: ….………………………………………………………….…. Designation: …………………………………………………………….………….

Telephone/ Cell phone: …………………………………………… Address: ……………………………………………………………………………

Official Stamp: ……………………………………………………………………………………………………………………………………..……………………………

Nairobi Office Mombasa Office Eldoret Office Kitengela Office Karatina Office Nkubu Office Kisii Office Kisumu Office O. Rongai Office
0719 312 309 0716 130 883 0729 287 451 0748 080 119 0748 080 086 0719 834 321 0716 130 884 0719 772 099 0726 498 199
0782 301 313 0782 601 188 0782 850 884 0782 301 118 0782 605 508 0782 601 015 0782 601 415 0782 599 822 0782 601 010

Page 2 of 4
 F. HOME SKETCH MAP

OFFICIAL USE ONLY

G. LOAN APPLICATION ANALYSIS

Total Deposits Kshs: ………………………………………….. Amount currently requested is Kshs: ……………………………………………

New total loans will be Kshs: ………………………………………………………………………………………………………………………………………..

ELEGIBILITY CALCULATIONS

Deposits: …………………………………………………………….. x3 = Kshs ……………………………………………………………………………………

Total guarantors cover the amount Yes No

H. RECOMMENDATION

Loan Officer: ………………………………………………..….. Amount: ……………………………..Sign: ……………….………. Date: ……………………….

Remarks: ………………………………………………………………………………………………………………………………………………………………………………

Credit Officer: ……………………………………..………….. Amount: ……………………………..Sign: ………………………... Date: ………………………

Remarks: …………………………………………………………………………………………………………………………………………………………………………..….

Nairobi Office Mombasa Office Eldoret Office Kitengela Office Karatina Office Nkubu Office Kisii Office Kisumu Office O. Rongai Office
0719 312 309 0716 130 883 0729 287 451 0748 080 119 0748 080 086 0719 834 321 0716 130 884 0719 772 099 0726 498 199
0782 301 313 0782 601 188 0782 850 884 0782 301 118 0782 605 508 0782 601 015 0782 601 415 0782 599 822 0782 601 010

Page 3 of 4
 I. CREDIT COMMITEE COMMENTS

Loan approved Kshs ………………………………………………recoverable in……………………………………installments at an interest rate of

1% (percent) on a reducing balance.

Name: ……………………………….…………………………. Sign: ……………………..……………………. Date: ………………………………….…………

Credit committee’s minute no: ………………………………………………………. Date: ……………………………………………………………….

If not approved, indicate the reason for the deferral or rejection.

Reason for deferred loans

o Incomplete information
o Dormant member
o Lack of supporting documents
Reason for rejected loans
o Bad repayment history
o Clear outstanding loan
o Lack of proper guarantors
o Membership period
o Ineligible purpose
o Inability to pay

Chairman’s signature: ………………………………………………………………… Date: ……………………………………………………………………

Member signature: ……………………………………………………………………. Date: ……………………………………………………………………

Member signature: ……………………………………………………………………. Date: ……………………………………………………………………

Nairobi Office Mombasa Office Eldoret Office Kitengela Office Karatina Office Nkubu Office Kisii Office Kisumu Office O. Rongai Office
0719 312 309 0716 130 883 0729 287 451 0748 080 119 0748 080 086 0719 834 321 0716 130 884 0719 772 099 0726 498 199
0782 301 313 0782 601 188 0782 850 884 0782 301 118 0782 605 508 0782 601 015 0782 601 415 0782 599 822 0782 601 010

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